Abstract T P16: Availability of Endovascular Services at Primary Stroke Centers

Abstract

Background: Endovascular treatments (EVTs) are useful for treating various types of cerebrovascular disease. There is little data about the availability of such services at stroke centers and how outcomes are tracked. Our hypothesis was that some of these services may be available at Primary Stroke Centers (PSCs), but that outcome tracking may be sub-optimal. Methods: We conducted an Internet-based survey of hospitals certified by The Joint Commission (TJC) as PSCs in the U.S. The survey inquired about EVTs such as IA lytics, IA mechanical clot removal, coiling of aneurysms, and cervical arterial stenting; physician training, coverage models, hospital type, and outcomes. We used chi-square analysis to detect differences between academic and community PSCs. Results: Data were available from 352 certified PSCs, of which 75% were community hospitals, 23% academic centers, and 80% were non-profit; almost half (48%) see 300 or more patients with acute ischemic stroke annually. A majority (60%) provided some or all EVTs on-site, while 29% had none on-site and no plans to add them. Among the respondents offering EVTs, 95% offered stenting of neck vessels, 86% IA lytics, 80% IA mechanical, and 74% aneurysm coiling. The majority (>55%) who did offer such services provided them 24/7/365. There were no significant differences in EVT service availability between academic and community PSCs. Most facilities (75%) would transfer a patient to a site with endovascular capability if a patient treated with IV TPA did not show a clinical response. Most endovascular coverage was provided by interventional neuroradiologists (60%), fellowship trained endovascular neurosurgeons (42%), and interventional radiologists (41%). More than half of treating physicians (53%) cover just one facility, while 22% cover 2 and 7% cover 3. The majority of hospitals (81%) did not participate in an audited national registry for EVTs, but 91% did track outcomes locally. Conclusions: EVT services are offered in both academic and community-based PSC hospitals. These services are typically available 24/7/365. Increasing participation in a national registry may be an opportunity to track and validate outcomes. How EVT availability at PSCs will impact the formation and number of CSCs remains unknown.